Category Archives: Affordable Care Act

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Health care in our country is a very political animal. Because of the huge amount of money there is to be made, namely by the health insurance industry, there are many special interests trying to claim their piece of the pie, and in doing so they have created the mess that is health and care in this country.

What other democratic and industrialized nation in this world has the process of health care delivery sitting before a court that may well decide that people like my husband don’t deserve to be able to purchase affordable insurance to live? The answer is none.

I have no answer for that but it is something this family is faced with every single day. From people on Twitter who regularly harangue me for speaking out in favor of the Affordable Care Act to yes, family members who are against it, I have to remind them all that the Affordable Care Act is saving lives. I also remind them that getting sick is part of the human condition and some of us get more sick than others.

And without the Pre-Existing Condition Insurance Plan, my husband and many others would die. It is that simple a truth; that black and white.

We pay a premium every month, just like those who have insurance through their employer. Until 2014 when the law is fully enacted (depending on the Roberts court, of course) and the health insurance exchanges are set up, your employer is the only access point for affordable health care.

The PCIP is a pool of people who the health insurance industry won’t insure. Why? Because the health insurance industry does not like to spread their risk pool out to people with diseases like Multiple Sclerosis or cancer because they know they will have to pay claims for these people. It’s the same with Medicare, the health insurance industry got rid of their most expensive risk pool, those over 65, when Medicare was created.

All insurance is a risk pool, we all pay into that pool to cover each other. I may never have a claim because I am healthy but my money goes to cover those who do and vice versa–that’s how insurance works. Imagine if we just opened up the Medicare risk pool to everyone, cradle to grave, and we all had the chance to pay into it. We’d solve all our problems, both with Medicare solvency and with insuring all our citizens.

The next time you hear someone, anyone, claim the Affordable Care Act is not affordable, ask them if they think it’s all right in this country of ours to allow one industry the right to deny care over and over again while taking in billions in profit.

“Throughout the debate, Senate Republicans have argued that this misguided law represents an unprecedented and unconstitutional expansion of the federal government into the daily lives of every American. Most Americans agree. In both public surveys and at the ballot box, Americans have rejected the law’s mandate that they must buy government-approved health insurance, and I hope the Supreme Court will do the same.”

Government approved health insurance? In 2014 it will be a mandate to buy insurance from private companies who pay to finance your campaigns, Senator. The government has given a gift to the private companies with this mandate rather than setting up a government run program, like Medicare, to give them some competition. What’s the solution–private health insurance or a government run program like Medicare for Everyone?

MCCONNELL: Well, it doesn’t make any difference frankly whether you opt-in or you opt-out, it’s still a government plan. You know, Medicaid, the program for the poor now, states can opt-out of that, but none of them have. I think if you have any kind of government insurance program, you’re going to be stuck with it and it will lead us in the direction of the European style, you know, sort of British-style, single payer, government run system. And those systems are known for delays, denial of care and, you know, if your particular malady doesn’t fit the government regulation, you don’t get the medication.

MILLER: Right.

MCCONNELL: And it may cost you your life. I mean, we don’t want to go down that path.

No, of course there are no delays or denial of care now, Senator McConnell because we only have 45,000 Americans die each year due to lack of health insurance, so a public program that would cover everyone would lead to–coverage and health care?

Americans..”don’t want is a Washington takeover of health care along the lines of what we’ve already seen with banks, insurance companies, and the auto industry. Americans don’t want a government-run system that puts bureaucrats between patients and doctors.”

The government has taken over the banks? The insurance companies? The auto industry? When did that happen? The only bureaucrats standing between patients and their doctors work for CIGNA, UnitedHealth, WellPoint and all the other health insurance companies.

Senator McConnell enjoys some of the finest government subsidized health care in the world thanks to the United States taxpayers, the Federal Employee Health Benefits Program. Ask the Senator from Kentucky if we should extend that government program to all United States citizens.

If you have been following this blog because you or a family member has Multiple Sclerosis you may know about the Sanofi takeover of Genzyme. Alternately, if you are one the many pharmaceuticals or investors or PR and advertising firms that visit us, you already do know that Sanofi completed the $20.1 billion buyout of Genzyme.

Which brings us to Campath (acquired from Bayer by Genzyme) now known, or trying to be known, as Lemtrada. We have written about it here because of the shameful desire to increase the price of a relatively inexpensive cancer treatment to $60,000 per year for Multiple Sclerosis treatment.

It is NOT YET APPROVED for use by the FDA. Campath/Lemtrada is still in clinical trials. Here is a link to the latest in their Clinical Trials.

At one point, Genzyme was giving Campath away for compassionate use in cancer patients. This was done by Genzyme to erase the yearly sales figures so that when the same drug rolls out (when approved) the $60,000 per year price sticker for Multiple Sclerosis won’t have a sales comparison number–of something much, much cheaper. Redefines the whole meaning of compassion, doesn’t it?

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Health Care Reform:

While the Affordable Care Act is not yet a law–we still have until 2014 for the whole thing to go into effect–the GOP is back to using their favorite catch phrase, “death panels.”

Here is a link to an article in Talking Points Memo about Rep. Phil Gingrey (R-GA) raising the dirty spectre of death panels and rationing yet again. Just an FYI, Rep. Gingrey voted to abolish Medicare. I think the good doctor should know better than to espouse what he does, but here’s the quote:

We’re the only democratic and industrialized nation in the world without a universal plan; a plan where anyone can buy into a risk pool and get themselves covered no matter what. We all get sick, it’s part of the human condition. It’s how we treat ourselves that defines our society.

If government is so bad, why does Dr. Gingrey want to use government to sharply cut medical malpractice awards? Won’t the free market just sort things out on its own?

But if Dr. Gingrey is speaking about the government creation of a high risk pool to help my husband and all Americans with pre-existing conditions get access to health care by purchasing insurance that will cover them, then I suggest he re-read his Hippocratic Oath.

Are we being threatened by rising costs? Yes. Why? Because Dr. Gingrey and his GOP ilk refuse to expand Medicare to Everyone. A national health plan that would compete for customers may inspire the private health insurers to actually produce a good product. Competition does that. As it is now, the private health insurers have zero competition.

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Now onto the National Multiple Sclerosis Society:

We got a flyer from the National MS Society the other day about their teleconference series that, “is designed to support individuals with MS through the continuum of their work experiences; from staying employed, to retraining and on to post-employment options. Understanding how to access vital resources will help individuals make the best choices through any stage of their workforce journey.”

With all the money the National MS Society takes in (and spends), this piece of writing just sent me over the edge as it purports to say something without saying anything at all. They paid for that with your donation dollars. And it gets worse:

Applying Through Your Employer’s Long Term Disability Benefits When MS Progresses

Featured speaker Lisa Kantor, LLP from Kantor and Kantor will share her expertise as an advocate who has successfully represented people in Employment Retirement Income Security Act (ERISA) benefit claims for over 18 years. If you have MS and Long Term Disability Insurance through your employer, you will want to know how to apply for and access these vital benefits.

Let me just begin by saying that the whole reason I’m here writing this, the whole reason this Foundation exists is because of the way my husband was treated both by his Long Term Disability insurance carrier, CIGNA.

He was denied his benefits by CIGNA. Twice. We had no where to turn for help, including the MS Society at the time.

This sort of teleconference series makes the National MS Society look good, but doesn’t really help. And with all the money they have, imagine what they could do. They could start by lobbying Congress to fix ERISA–that would go a long way in helping not just those with MS but all who have been denied their benefits or who have been mistreated by their health insurer.

Listening to Ms. Kantor may be helpful, she may even gain a few clients from this teleconference, but she can’t help you “apply for and access these vital benefits.” She simply cannot and that has nothing to do with Ms. Kantor.

See, one cannot actually access their long term disability benefits. I wrote extensively about that over at Illness and Insurance Hell.

Your insurance carrier starts the process while you are still on short-term disability; they will insist you apply for Social Security benefits and prove that you have been through that process or else they’ll deny your claim. They will even offer you help with one of their attorneys to make sure you go through the Social Security process.

To make matters even worse, they will obfuscate the truth (that’s called lying) in the face of medical evidence; they make things up. And when they are threatened with legal action, they send photographers (bad ones I’d like to add) to your house to photograph you and your family. My husband has lesions on his brain and spinal cord, could the guy with the camera, snapping away at us, somehow disprove that?

Which brings me back to the Affordable Care Act, the Ryan plan to abolish Medicare and the GOP still trying to get rid of health care reform.

I ask this: If the GOP succeeds in repealing health care (doubtful) but say they do, then the provisions in the law that help people, that stop lifetime caps, give seniors free preventative care, that fill the Medicare donut hole, that stops insurers from retroactively cancelling your plan, that gives Medicare drug discounts–if the GOP stops all this then what good is that $8,000 Ryan Voucher?

The pre-existing insurance plan created as part of The Affordable Care Act has always been a sore point with this Foundation and with many health care activists and with good reason. The eligibility rules surrounding the plan were written with political motivation behind them.

For example, my husband has Multiple Sclerosis and to apply for the high risk pool, he had to go and apply for coverage with a private insurance company and furnish a letter of denial. Not hard to do when one has Progressive-Relapsing Multiple Sclerosis. But think about the ridiculousness of this exercise in futility.

Thankfully, things have changed for the better and certain restrictions are gone.

But there is still one sticking point and that’s the rule stating that a person with a pre-existing condition must be WITHOUT insurance for six months prior to applying to the high risk pool still stands. Progress is slow.

The Obama administration, expanding a program created by the new healthcare law, moved Tuesday to make health insurance more affordable and accessible for Americans who have been denied coverage because they are sick.

Across the country, the federal government is reducing premiums on special coverage available to uninsured people with preexisting conditions such as cancer or diabetes.

And the administration is loosening restrictions on who can sign up for so-called preexisting condition insurance plans.

These plans were created by the health overhaul that President Obama signed last year. They are meant to provide temporary aid to sick Americans until 2014, when insurance companies will no longer be allowed deny coverage to people who are sick.

But the number of people signing up for these plans has lagged, in part because of high premiums and stringent eligibility guidelines.

Now, federal officials estimate, premiums in some states could come down as much as 40%, thanks to a more refined analysis of what the plans should charge.

The administration is directly slashing premiums in the District of Columbia and most of the 23 states that have elected to have the federal government run their health plans. The remaining 27 states, which each run their own plans, will be able to reduce premiums, as well.

At the same time, the administration will no longer require applicants for these plans to furnish a letter from an insurance company showing they had been denied coverage. Instead, applicants will need only a letter from a doctor, nurse or physician’s assistant stating they have a medical condition.

Under the House Republican plan, the government holds fixed the amount of money it’s willing to pay per patient per year, and leaves the residual costs for seniors to sort out with private insurers. Because private insurers are smaller, profit-driven, and less efficient than Medicare, those out-of-pocket costs will be significantly higher than they are now. And they’d grow much, much faster. Over the course of the program’s 75 year planning period, the difference would amount to $34 trillion.

And while they are trying to take away the Medicare you paid for all your working lives, the GOP is still trying to repeal or defund the Affordable Care Act, where the new health care laws were put into place to stop the health insurance industry from some of its more pernicious acts against sick people.

Want to know Paul Ryan’s net worth–and all members of Congress as well? Go to Open Secrets and find out. You can search by individual and even download the list of all members of Congress–the ones you pay to represent you. From Open Secrets:

Imagine, if you will, the security of never fearing you are just one pink slip away from a health care related financial disaster or knowing that you will not have to declare bankruptcy if you lose your job and have a pre-existing condition like Multiple Sclerosis.

You will always be able to pay into a Single Payer system and be covered. And the more people in the pool, the more costs are contained.

Here’s Vermont for Single Payer dot org’s Top 10 Reasons for the Single Payer system.

Think Progress has been reporting on this and here is a link to the article. However, there still are some hurdles to a civil society:

For those of you unfamiliar with ERISA laws, be glad you are. The federal ERISA (Employee Retirement Incoms Security Act) laws were in enacted in 1974 and meant to protect employees from having their pension funds ravaged by crooked CEOs. It also covers health plans and there’s the problem. More on ERISA here, here and here. Please read these links, they explain everything in detail.

During the debate over the Affordable Care Act two specifics were brought to the table to help the consumer. The first was get rid of ERISA for health plans. Guess what? The insurance lobby (AHIP) won on that one and we still have it.

And the second was get rid of the McCarran Ferguson Act of 1945, the one where the insurance industry is immune to Federal Anti-Trust Laws (like Major League Baseball). You guessed it, the insurance lobby won out again over the consumer.

If you are a believer in states’ rights then I urge you to write your members of Congress and tell them to do away with these two federal laws and put the rights back in the hands of your state. You’ll be healthier! And Single Payer or Medicare for Everyone.

As for Ryan’s plan, CBO’s take was just the opposite. “Under the proposal,” they said, “most elderly people would pay more for their health care than they would pay under the current Medicare system.” That is to say, health-care costs go up.